Incidental intrahepatic portal vein-hepatic vein fistula
Incidental finding on CT abdomen for suspected renal obstruction.
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Abnormal collection of vessels in the left hepatic lobe, fed from the left portal vein and draining via the middle hepatic vein into the IVC. Note dilatation of the biliary tree possibly related to previously cholecystectomy. The hepatic enhancement pattern is also a little patchy, possibly due to perfusion phenomenon due to the diversion of portal venous blood through the fistula.
These shunts are rare, usually in the left hepatic lobe and often of dubious significance. The connection is often aneurysmal (not in this case). The patients often do not have cirrhosis nor have they had medical interventional. They rarely require treatment but can be associated with hepatic encephalopathy due to bypass of liver metabolism by portal venous blood.